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University of CaliforniaStudent Health Insurance Plan (UC SHIP)Office of the President, Risk Services2013-2014
5 HEALTH INSURANCE OPTIONSAFTER UC SHIP1.Covered California marketplace exchange. Help withpremium subsidies and Medi-Cal enrollment, too.2.Public health care programs, help at Covered California3.You can stay on your parents’ employer plan until age 264. UC SHIP Continuation Plan for one academic term5.UC Alumni Association health care program
Covered CaliforniaA new world of health care insurance options The Patient Protection and Affordable Care Act (ACA) passed in2010 will be enacted on January 1, 2014. Most Americans must havehealth care insurance or face a tax penalty. Visit www.CaliforniaCa.com to review affordable Californiaexchange plans, use a Shop and Compare tool for easy-to-read planbenefit and cost comparison. Covered California customer service will help you find the rightplan for you and your family and see if you qualify for premiumsubsidies, Medi-Cal or other public programs Premium subsidies are available for low-income individuals whoare not eligible for Medi-Cal, see if you qualify atwww.CoveredCa.com
Covered California: Who can enroll? You must be a California resident. Open enrollment for a Covered California plan continuesuntil to March 31st for coverage in 2014 if you apply by the15th of the month. Coverage will begin the 1st of the nextmonth. Your health plan will contain: No pre-existing condition limitations 10 Minimum Essential Coverage benefits No lifetime or annual benefit limits on Essential Coverage
Covered CaliforniaA new world of health care insurance options: Shop ‘n Compare If you become covered by an employer plan, Covered Californiaoffers plans that may save money for family members Each family member can enroll in a separate Covered Californiaplan Premium subsidies and lower out-of-pocket costs are availableto qualified low-income individuals By law, your insurance cannot be cancelled because you get sick
Public Health Insurance ProgramsONE STOP SHOP through Covered California’s partnership with theCalifornia Department of Health Care Services (DHCS). Visitwww.Coveredca.com for assistance with Covered California exchangeplans, premium subsidies and Medi-Cal enrollment. Medi-Cal for Families: Families (adults and children) who are eligible through theCalWORKS program, or a single adult solely responsible for child/children. Enrollthrough Covered California, www.Coveredca.com Pregnancy-related Programs: Medi-Cal and Access for Infants and Mothers (AIM):Services are provided to women who are under or uninsured — regardless ofimmigration status. This is short-term coverage; until 60 days after childbirth Aid-related Programs: Individuals who receive cash aid through certain federalgovernment programs are automatically entitled to Medi-Cal, including CalWORKS andSupplemental Security Income (SSI)Medi-Cal programs, require financial eligibility, and the individual or family may have a cost-share requirement
Are you under age 26? If you have dual coverage with UC SHIP and your parents’employer health plan, Health Care Reform law allows you tostay on your parents’ plan until your 26th birthday. If you dropped your parents’ health plan when you startedUC SHIP, Health Care Reform law allows you to re-enroll andremain on your parents’ health plan until your 26th birthday.To re-enroll, request a Certificate of Creditable Coverage From AnthemBlue Cross Customer Service—(866) 940-8306 to prove loss of coverage.Remember, the Covered California marketplace may offer lower-cost options than yourparents’ employer plan. Go to www.CoveredCa.com to Shop ‘n Compare.Enroll by March 31st for coverage in 2014.
UC SHIP Continuation PlanStudents enrolled in UC SHIP may continue for one term aftergraduation Same great benefits! Medical – Pharmacy - Counseling - Dental - Vision No pre-existing condition limitations ever Add or continue dependent plan benefits Enrollment is voluntary; premium is different Check with your campus student health services to see if their servicesare available to new alumni enrolled in UC SHIP and if you need areferral to access Anthem’s provider network
UC SHIP Continuation PlanTo Enroll in UC SHIP for one term after graduation, contact:Wells Fargo Insurance ServicesPhone: (800) 853-5899; FAX (916) 231-0527Address: 10940 White Rock Road, 2 Floor, Rancho Cordova, CA 95670The full premium must be paid prior to receiving coverageWhat about COBRA after I leave UC SHIP?Student health insurance plans are not subject to federal or stateCOBRA laws, so COBRA is not available to UC SHIP members whograduate or leave the university for reasons other than graduation.
Some UC campus Alumni Associations offer healthinsurance to graduating students - check it outCheck with your campus Alumni Association. SomeAssociations offer insurance plans for graduates to purchase atdiscounted rates. Long-term& short-term plans Discounts are available on some campuses, with a health questionnaire The new graduate must join the Alumni Association to qualify for the insuranceprogramRemember to Shop ‘n Compare at www.Coveredca.com. You may be ableto find the best coverage for the lowest cost through California’s healthinsurance marketplace exchange. You must be a California resident.
General Insurance Information Be an informed health insurance consumer Do your home work! Glossary of insurance terms RESOURCES
Be an Informed Consumer!Health Care IS a commodity1.Compare plans and prices 2.Visit www.Coveredca.com for a plan comparison toolContact Private Insurance company customer serviceKnow what you are purchasingMONEY — Monthly premium, deductible(s), coinsurance, copayments, out-of-pocket maximumSERVICES — what’s covered and what’s nothow are services reimbursed (what’s your responsibility?)EXCLUSIONS — e.g., deductible before maternity benefits kick in, prescription drugsLIMITATIONS — e.g., inpatient and outpatient behavioral health services
HOW INSURANCE WORKS—Identify your costsWHEN YOU ARE SHOPPING FOR INSURANCE, DO YOUR HOMEWORK! MAKE NOTES ON WHAT YOUWILL BE REQUIRED TO PAY FOR EACH OF THE FOLLOWING:PREMIUM Fee (rates) you pay to be enrolled in an insurance plan, usually monthlyDEDUCTIBLE or Annual Amount you must pay for services out of your own pocket first, before the insurer will payfor medical and pharmacy services. Other deductibles may applyCO-INSURANCE %Percentage share of cost you and the insurer (carrier) pay, expressed in % for each service(variable; e.g., 20%), after the annual deductible is satisfiedCOPAYMENT Set-dollar share of cost for each service (variable; e.g., 20); not subject to deductibleINSURANCE COMPANY pays:BALANCE after YOU meet the deductible and pay co-insurance or copayment (if any), for eachservice — subject to policy terms (i.e., for covered, medically necessary services)
Glossary of Key Health Insurance Terms HMO (Health Maintenance Organization)A plan in which you choose a primary care physician (PCP) who coordinates care with providersin the plan network—no coverage outside network PPO (Preferred Provider Organization)A plan in which you have direct access to providers in the plan network, as well as non-networkproviders at higher cost to you Network or “Participating” Providers: Providers (individuals and facilities) accept anegotiated or contracted rate as full payment for services—no “balance billing” UC SHIP is a PPO Plan (Anthem’s Prudent Buyer Network) but is unique because it requiresstudents to obtain a written referral prior to receiving services outside of student healthservicesHigh Deductible PlanAnnual deductible is higher than usual ( 1500 or higher) and must be paid before plan benefits are paid.
Glossary of Key Health Insurance Terms Maximum Allowed AmountThe maximum amount the carrier will reimburse for aparticular service Out of Pocket Maximum Maximum dollar amount you have to pay out of your own pocket forcovered health care services during the plan year.For example, UC SHIP’s In Network out of pocket maximum is 3,000 Lifetime Maximum The Affordable Care Act passed in 2010 prohibits lifetime maximums orannual maximums on Essential Health Benefits UC SHIP’s benefits are unlimited
RESOURCES Covered California health care plan exchange:www.Coveredca.com California HealthCare Foundation: www.chcf.org Kaiser Family Foundation: research and bulletins about policy www.kff.org HealthCare.Gov: provides information on insurance options, comparing carequality and understanding the new law www.healthcare.gov California Office of the Patient Advocate: independent office in stategovernment for HMO members www.opa.ca.gov California Departments of Health Care Serviceswww.dhcs.ca.gov, Insurance www.doi.ca.gov, & ManagedHealth Care www.dmhc.ca.gov Managed Risk Medical Insurance Board: www.mrmib.ca.gov
Special Thanks to:UC Berkeley’s StudentHealth InsuranceOffice for supplyingslides that served asthe basis for thispresentation.
UC SHIP Continuation Plan To Enroll in UC SHIP for one term after graduation, contact: Wells Fargo Insurance Services Phone: (800) 853-5899; FAX (916) 231-0527 Address: 10940 White Rock Road, 2 Floor, Rancho Cordova, CA 95670 The full premium must be paid prior to receiving coverage
